Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series
Background and purposeThe treatment of complex intracranial aneurysms can be challenging with stand-alone open or endovascular techniques, particularly after rupture. A combined open and endovascular strategy can potentially limit the risk of extensive dissections with open-only techniques, and allo...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-04-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1102496/full |
| _version_ | 1797843254244278272 |
|---|---|
| author | Robert C. Rennert Vincent N. Nguyen Aidin Abedi Aidin Abedi Nadia A. Atai Nadia A. Atai Joseph N. Carey Matthew Tenser Arun Amar William J. Mack Jonathan J. Russin Jonathan J. Russin |
| author_facet | Robert C. Rennert Vincent N. Nguyen Aidin Abedi Aidin Abedi Nadia A. Atai Nadia A. Atai Joseph N. Carey Matthew Tenser Arun Amar William J. Mack Jonathan J. Russin Jonathan J. Russin |
| author_sort | Robert C. Rennert |
| collection | DOAJ |
| description | Background and purposeThe treatment of complex intracranial aneurysms can be challenging with stand-alone open or endovascular techniques, particularly after rupture. A combined open and endovascular strategy can potentially limit the risk of extensive dissections with open-only techniques, and allow for aggressive definitive endovascular treatments with minimized downstream ischemic risk.Materials and methodsRetrospective, single-institution review of consecutive patients undergoing combined open revascularization and endovascular embolization/occlusion for complex intracranial aneurysms from 1/2016 to 6/2022.ResultsTen patients (4 male [40%]; mean age 51.9 ± 8.7 years) underwent combined open revascularization and endovascular treatment of intracranial aneurysms. The majority of aneurysms, 9/10 (90%), were ruptured and 8/10 (80%) were fusiform in morphology. Aneurysms of the posterior circulation represented 8/10 (80%) of the cases (vertebral artery [VA] involving the posterior inferior cerebellar artery [PICA] origin, proximal PICA or anterior inferior cerebellar artery/PICA complex, or proximal posterior cerebral artery). Revascularization strategies included intracranial-to-intracranial (IC-IC; 7/10 [70%]) and extracranial-to-intracranial (EC-IC; 3/10 [30%]) constructs, with 100% postoperative patency. Initial endovascular procedures (consisting of aneurysm/vessel sacrifice in 9/10 patients) were performed early after surgery (0.7 ± 1.5 days). In one patient, secondary endovascular vessel sacrifice was performed after an initial sub-occlusive embolization. Treatment related strokes were diagnosed in 3/10 patients (30%), largely from involved or nearby perforators. All bypasses with follow-up were patent (median 14.0, range 4–72 months). Good outcomes (defined as a Glasgow Outcomes Scale ≥4 and modified Rankin Scale ≤2) occurred in 6/10 patients (60%).ConclusionA variety of complex aneurysms not amenable to stand-alone open or endovascular techniques can be successfully treated with combined open and endovascular approaches. Recognition and preservation of perforators is critical to treatment success. |
| first_indexed | 2024-04-09T17:02:12Z |
| format | Article |
| id | doaj.art-88581207dbb3439ea4d370a0adcdf6a8 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-09T17:02:12Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-88581207dbb3439ea4d370a0adcdf6a82023-04-21T04:39:14ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-04-011410.3389/fneur.2023.11024961102496Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case seriesRobert C. Rennert0Vincent N. Nguyen1Aidin Abedi2Aidin Abedi3Nadia A. Atai4Nadia A. Atai5Joseph N. Carey6Matthew Tenser7Arun Amar8William J. Mack9Jonathan J. Russin10Jonathan J. Russin11Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesDepartment of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesDepartment of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesNeurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesDepartment of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesNeurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesDivision of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesDepartment of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesDepartment of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesDepartment of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesDepartment of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesNeurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesBackground and purposeThe treatment of complex intracranial aneurysms can be challenging with stand-alone open or endovascular techniques, particularly after rupture. A combined open and endovascular strategy can potentially limit the risk of extensive dissections with open-only techniques, and allow for aggressive definitive endovascular treatments with minimized downstream ischemic risk.Materials and methodsRetrospective, single-institution review of consecutive patients undergoing combined open revascularization and endovascular embolization/occlusion for complex intracranial aneurysms from 1/2016 to 6/2022.ResultsTen patients (4 male [40%]; mean age 51.9 ± 8.7 years) underwent combined open revascularization and endovascular treatment of intracranial aneurysms. The majority of aneurysms, 9/10 (90%), were ruptured and 8/10 (80%) were fusiform in morphology. Aneurysms of the posterior circulation represented 8/10 (80%) of the cases (vertebral artery [VA] involving the posterior inferior cerebellar artery [PICA] origin, proximal PICA or anterior inferior cerebellar artery/PICA complex, or proximal posterior cerebral artery). Revascularization strategies included intracranial-to-intracranial (IC-IC; 7/10 [70%]) and extracranial-to-intracranial (EC-IC; 3/10 [30%]) constructs, with 100% postoperative patency. Initial endovascular procedures (consisting of aneurysm/vessel sacrifice in 9/10 patients) were performed early after surgery (0.7 ± 1.5 days). In one patient, secondary endovascular vessel sacrifice was performed after an initial sub-occlusive embolization. Treatment related strokes were diagnosed in 3/10 patients (30%), largely from involved or nearby perforators. All bypasses with follow-up were patent (median 14.0, range 4–72 months). Good outcomes (defined as a Glasgow Outcomes Scale ≥4 and modified Rankin Scale ≤2) occurred in 6/10 patients (60%).ConclusionA variety of complex aneurysms not amenable to stand-alone open or endovascular techniques can be successfully treated with combined open and endovascular approaches. Recognition and preservation of perforators is critical to treatment success.https://www.frontiersin.org/articles/10.3389/fneur.2023.1102496/fullcerebral revascularizationbypassaneurysmneuroendovascular approachembolization |
| spellingShingle | Robert C. Rennert Vincent N. Nguyen Aidin Abedi Aidin Abedi Nadia A. Atai Nadia A. Atai Joseph N. Carey Matthew Tenser Arun Amar William J. Mack Jonathan J. Russin Jonathan J. Russin Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series Frontiers in Neurology cerebral revascularization bypass aneurysm neuroendovascular approach embolization |
| title | Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series |
| title_full | Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series |
| title_fullStr | Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series |
| title_full_unstemmed | Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series |
| title_short | Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series |
| title_sort | combined open revascularization and endovascular treatment of complex intracranial aneurysms case series |
| topic | cerebral revascularization bypass aneurysm neuroendovascular approach embolization |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1102496/full |
| work_keys_str_mv | AT robertcrennert combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT vincentnnguyen combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT aidinabedi combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT aidinabedi combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT nadiaaatai combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT nadiaaatai combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT josephncarey combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT matthewtenser combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT arunamar combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT williamjmack combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT jonathanjrussin combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries AT jonathanjrussin combinedopenrevascularizationandendovasculartreatmentofcomplexintracranialaneurysmscaseseries |